Klimas Annegret, Lemmer Andreas, Bergert Hendrik, Brodhun Michael, Scholbach Thomas, Großer Kay
1 Department of Pediatric Surgery and Pediatric Urology, HELIOS Klinikum Erfurt, Germany.
Vasa. 2015 Jul;44(4):305-12. doi: 10.1024/0301-1526/a000446.
The celiac artery compression syndrome (CACS) is a rarely diagnosed disorder, which is characterized by chronic abdominal pain and vegetative symptoms. The role of surgical treatment in celiac artery decompression has been discussed controversially by numerous authors. After first casuistic descriptions of a laparoscopic treatment in adults we established this novel minimally invasive procedure for treatment in children and adolescents.
Between 2005 and 2014 we operated 58 patients (47 female, 11 male) from 7 to 25 years who had been diagnosed with celiac artery compression. The patients presented with severe chronic abdominal pain, vegetative symptoms and a reduced quality of life. Doppler sonography showed an increased blood flow velocity of the celiac artery with maximum of 190 - 450 cm/s (mean 259 cm/s).MR angiography demonstrated a characteristic hook-shaped appearance of the celiac artery with severe localized compression.
All patients underwent laparoscopic decompression of the celiac artery. We observed complications in 3 patients (5,2 %). Postoperatively all patients (100 %) were immediately free of abdominal pain. Doppler sonography showed a marked reduction in celiac blood flow velocity to 70 - 190 cm/s postoperatively (mean 178 cm/s). A return of vessel diameters to normal dimensions was documented by postoperative MR angiography. During a median follow up of 62 months we observed a recurrence of the celiac artery compression in 4 patients (6,9 %).
Laparoscopic treatment of celiac artery compression syndrome offers a novel, safe, reliable and, compared to open surgery, less invasive approach. The surgical treatment is indicated in patients with characteristic symptoms and typical findings at Doppler sonography and MRA after exclusion of other abdominal pathologies. The work-up of chronic abdominal pain in children and adolescents should include a color Doppler sonography to look for celiac artery compression.
腹腔动脉压迫综合征（CACS）是一种诊断较少的疾病，其特征为慢性腹痛和自主神经症状。众多作者对手术治疗在腹腔动脉减压中的作用进行了颇具争议的讨论。在首次对成人腹腔镜治疗进行病例报告后，我们开展了这种用于儿童和青少年治疗的新型微创手术。
2005年至2014年间，我们为58例年龄在7至25岁、被诊断为腹腔动脉压迫的患者实施了手术（47例女性，11例男性）。这些患者表现为严重的慢性腹痛、自主神经症状及生活质量下降。多普勒超声显示腹腔动脉血流速度增加，最高可达190 - 450厘米/秒（平均259厘米/秒）。磁共振血管造影显示腹腔动脉呈特征性的钩形外观且有严重的局部压迫。
所有患者均接受了腹腔动脉腹腔镜减压术。我们观察到3例患者（5.2%）出现并发症。术后所有患者（100%）立即腹痛消失。多普勒超声显示术后腹腔动脉血流速度显著降低至70 - 190厘米/秒（平均178厘米/秒）。术后磁共振血管造影记录到血管直径恢复至正常大小。在中位随访62个月期间，我们观察到4例患者（6.9%）腹腔动脉压迫复发。
腹腔镜治疗腹腔动脉压迫综合征提供了一种新型、安全、可靠且与开放手术相比侵入性较小的方法。在排除其他腹部病变后，对于有特征性症状以及多普勒超声和磁共振血管造影有典型表现的患者，应进行手术治疗。儿童和青少年慢性腹痛的检查应包括彩色多普勒超声以查找腹腔动脉压迫情况。
